术中冰冻或术后石蜡病理报告T1b期胆囊癌的外科治疗策略

发布时间：2018-05-10 05:02

本文选题：胆囊肿瘤 + 肿瘤分期　；参考：《北京大学学报(医学版)》2017年06期

【摘要】：目的:探讨术中冰冻或术后石蜡病理报告T1b期胆囊癌的外科治疗策略。方法:回顾42例T1b期胆囊癌患者的病理资料,其中14例为术中冰冻病理,28例为术后石蜡病理。经病理科医师重新复核,26例明确为T1b期胆囊癌,其中25例患者获得完整随访资料,本研究对其进行进一步的分析。结果:14例冰冻病理为T1b期的胆囊癌患者仅2例石蜡病理为T1b期,其余11例为T2期,1例为T3期,冰冻病理误诊率为85.7%,石蜡病理均等于或高于冰冻病理分期;28例石蜡病理为T1b期的胆囊癌患者2例复核为T2期,石蜡病理误诊率为7.1%,复核结果均等于或高于原分期。25例复核明确且有完整随访资料患者术后病理均未见胆囊脉管内癌栓或神经侵犯,其中14例行根治手术患者送检淋巴结30枚,均未见癌转移。25例患者中11例仅行单纯胆囊切除术,其余14例追加腹腔镜或开腹根治手术,两组间生存率差异无统计学意义(P=0.361)。仅1例行腹腔镜根治术及胆囊减压的患者发生腹腔种植转移,术后2年因广泛种植转移而死亡。结论:胆囊切除术中冰冻病理T1b期胆囊癌应行同期根治手术,术后石蜡病理T1b期胆囊癌应复核其T分期,对复核明确的T1b期胆囊癌需慎重评估追加根治手术的利弊,如果术中有胆囊破损建议积极化疗。
[Abstract]:Objective: to investigate the surgical treatment strategy of T 1b gallbladder carcinoma in frozen or postoperative paraffin wax. Methods: the pathological data of 42 patients with stage T 1b gallbladder carcinoma were reviewed. Twenty-six cases of T1b gallbladder carcinoma were reviewed by pathologists and 25 of them were followed up. Results in 14 cases of gallbladder carcinoma with frozen pathology, only 2 cases had stage T 1b in paraffin wax, 11 cases had stage T 2 and 1 case had stage T 3. The misdiagnosis rate of frozen pathology was 85.7%, and the paraffin pathology was equal to or higher than that of frozen pathological staging in 28 cases of gallbladder carcinoma with T 1b stage. The misdiagnosis rate of paraffin wax pathology was 7.1. The results of the review were equal to or higher than those of the original staging. There were no intraductal carcinoma embolus or nerve invasion in 25 patients with definite and complete follow-up data. Among them, 30 lymph nodes were examined in 14 patients undergoing radical operation. Of the 25 cases of cancer metastasis, 11 cases were treated with simple cholecystectomy, the other 14 cases received laparoscopy or radical laparotomy. There was no significant difference in survival rate between the two groups (P < 0. 361). Only one patient underwent laparoscopic radical operation and gallbladder decompression developed abdominal implantation metastasis and died 2 years after operation due to extensive implantation metastasis. Conclusion: the frozen pathological stage T 1b gallbladder carcinoma should be treated with radical operation simultaneously, and the T stage of T 1b gallbladder carcinoma with paraffin wax pathology should be reviewed after cholecystectomy. The advantages and disadvantages of the additional radical operation should be carefully evaluated for the clear T 1b gallbladder carcinoma. Active chemotherapy is recommended if gallbladder breakage occurs during the operation.
【作者单位】：北京大学第三医院普外科;北京大学第三医院病理科;北京大学第三医院临床流行病学研究中心;
【分类号】：R735.8

【相似文献】